PRENATAL DIAGNOSISIMAGING

PRENATAL DIAGNOSISIMAGING

ULTRASOUND

EMBRYOSCOPY

FETAL MEDICINEULTRASOUND IMAGING

FETAL MEDICINEULTRASOUND IMAGING

DATING MULTIPLE PREGNANCY ANOMALY SCREENING FETAL GROWTH

AMNIOTIC FLUID VOLUME PLACENTAL LOCALISATION

DOPPLER STUDIES FETAL WELL-BEING GUIDANCE OF INVASIVE PROCEDURES PSYCHOLOGICAL ASPECTS

FETAL MEDICINEULTRASOUND IMAGING

FETAL MEDICINEULTRASOUND IMAGING

ULTRASOUND SCREENING DURING PREGNANCY

I : 11 - 14 WKS

II : 19 – 21 WKS

III: 32 - 36 WKS

ULTRASOUND SCREENING DURING PREGNANCY

ULTRASOUND SCREENING DURING PREGNANCY

FIRST EXAMINATION (11-14 WKS)

UTERUS, ADNEXAE GESTATIONAL AGE CHORIONICITY IN MULTIPLE PREGNANCIES NUCHAL TRANSLUCENCY (NT) EARLY MORPHOLOGY

ASSESSMENT OF GESTATIONAL AGEASSESSMENT OF GESTATIONAL AGE

MEAN GESTATIONAL SAC DIAMETER +/- 7d

CROWN RUMP LENGTH (CRL) +/- 5d

BIPARIETAL DIAMETER (BPD) +/- 7 d < 20 wks +/- 10d 20-26 wks +/- 2 wks 27-29 wks +/- 2.5 wks 30-32 wks +/- 3 wks > 33 wks FEMUR LENGTH (FL)

OTHER PARAMETERS (CEPHALIC CIRCUMFERENCE, HUMERUS LENGTH, CEREBELLUM, FOOT LENGTH)

ULTRASOUND SCREENING DURING PREGNANCY

ULTRASOUND SCREENING DURING PREGNANCY

FIRST EXAMINATION (11-14 WKS)

UTERUS, ADNEXAE GESTATIONAL AGE CHORIONICITY IN MULTIPLE PREGNANCIES NUCHAL TRANSLUCENCY (NT) EARLY MORPHOLOGY

FIRST-TRIMESTER SCREENING FOR FETAL ANEUPLOIDIES

FIRST-TRIMESTER SCREENING FOR FETAL ANEUPLOIDIES

NUCHAL TRANSLUCENCY MEASUREMENT:

1. CRL 41 - 80 mm 2. MEDIAN SAGITTAL SECTION OT THE FETUS IN NEUTRAL POSITION 3. DISTINCTION BETWEEN FETAL SKIN AND AMNION 4. THE FETUS SHOULD OCCUPY AT LEAST 75% OF THE IMAGE 5. MAXIMUM THICKNESS OF NT SHOULD BE MEASURED 6. CALLIPERS SHOULD BE PLACED ON THE LINES Snijders RJM et al. Lancet 1998; 352: 343-6

FIRST-TRIMESTER SCREENING FOR FETAL ANEUPLOIDIES

FIRST-TRIMESTER SCREENING FOR FETAL ANEUPLOIDIES

SECONDARY BENEFITS OF NT MEASUREMENT:

WHEN THE FETAL KARYOTYPE IS NORMAL, A NT > 95th CENTILE MAY BE ASSOCIATED WITH:

1. CONGENITAL CARDIOPATHIES

2. OTHER FETAL ANOMALIES (ORGANIC / SYNDROMIC)

ULTRASOUND SCREENING DURING PREGNANCY

ULTRASOUND SCREENING DURING PREGNANCY

SECOND EXAMINATION (19-21 WKS)

GESTATIONAL AGE MARKERS OF ANOMALY / ANEUPLOIDY FETAL MORPHOLOGY I PLACENTAL LOCALISATION

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

FETAL ANOMALY SCREENING

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

HEAD SPINE THORAX (HEART) DIAPHRAGMA ABDOMEN EXTREMITIES UMBILICAL CORD FETAL GENDER (?)

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

HEAD

CRANIUM CEREBRAL STRUCTURES VENTRICLES, POSTERIOR FOSSA ADDITIONNAL STRUCTURES ?

BIPARIETAL DIAMETER OTHER MEASUREMENTS WHEN NEEDED

FACIAL STRUCTURES, PROFILE

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

RACHIS

LONGITUDINAL, TRANSVERSE AND FRONTAL VIEWS

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

THORAX

HEART: POSITION / AXIS, DIMENSIONS, RHYTHM, 4 CHAMBERS, OUTFLOW TRACTS

THORACIC WALL, RIBSTHORACIC CIRCUMFERENCE IF NEEDED

ADDITIONNAL STRUCTURES ?

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

DIAPHRAGMA

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

ABDOMEN

DIAMETERS AND/OR CIRCUMFERENCE

CORD INSERTION STOMAC, LIVER, GALLBLADER, UMBILICAL VEIN

KIDNEYS: DIMENSIONS, STRUCTURES BLADDER: PRESENCE (DYNAMIC EVALUATION)

ADDITIONNAL IMAGES ?

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

EXTREMITIES

FEMORAL LENGTHMEASUREMENTS OF OTHER LONG BONES WHEN NEEDED

PRESENCE OF ALL 4 EXTREMITIES AND THEIR SEGMENTS MOBILITY ATTITUDE POLYDACTILY ?

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

UMBILICAL CORD

NUMBER OF VESSELS

FETAL MORPHOLOGY SCANFETAL MORPHOLOGY SCAN

FETAL SEX (?)

FETAL MORPHOLOGY SCANCRITICAL POINTS

FETAL MORPHOLOGY SCANCRITICAL POINTS

1. TIMING

2. COMPREHENSIVE AND SYSTEMATIC EXAMINATION 3. EXPERIENCE OF NORMAL FETAL IMAGES

4. ONLY ADEQUATELY VISUALISED STRUCTURES SHOULD BE EVALUATED

5. IMAGING CONDITIONS

US MARKERS OF FETAL ANOMALIESUS MARKERS OF FETAL ANOMALIES

OLIGOHYDRAMNIOS POLYHYDRAMNIOS EARLY GROWTH RETARDATION DYSHARMONIOUS FETAL GROWTH ABNORMAL MOTOR ACTIVITY CARDIAC ARRYTHMIAS

US MARKERS OF FETAL ANEUPLOIDY

US MARKERS OF FETAL ANEUPLOIDY

2ND-TRIMESTER OLIGOHYDRAMNIOS POLYHYDRAMNIOS EARLY GROWTH RETARDATION DYSHARMONIOUS GROWTH NON-IMMUNOLOGIC HYDROPS ABNORMAL PROFILE STRUCTURAL ANOMALIES SINGLE UMBILICAL ARTERY ABNORMAL MOTOR ACTIVITY

ULTRASOUND SCREENING DURING PREGNANCY

ULTRASOUND SCREENING DURING PREGNANCY

THIRD EXAMINATION (32-36 WKS)

FETAL GROWTH FETAL MORPHOLOGY II (CNS, HEART, URINARY AND DIGESTIVE TRACTS, DIAPHRAGMA) AMNIOTIC FLUID PLACENTAL LOCALISATION

ULTRASOUND IN OBSTETRICSULTRASOUND IN OBSTETRICS

DOPPLER EVALUATION OF FETAL AND UTERO-PLACENTAL CIRCULATIONS

PRENATAL DIAGNOSISPRENATAL DIAGNOSIS

EMBRYOSCOPY

DIRECT, DETAILED OBSERVATION OF FETAL ANATOMY AND INTEGUMENT

TRANSCERVICAL / TRANSABDOMINAL

FETAL MEDICINEULTRASOUND IMAGING

FETAL MEDICINEULTRASOUND IMAGING

ACCEPTED (PROVEN) BENEFITS

1. BETTER GESTATIONAL AGE ASSESSEMENT

2. EARLIER DETECTION OF MULTIPLE PREGNANCIES

3. EARLIER DETECTION OF CLINICALLY UNSUSPECTEDFETAL MALFORMATIONS

FETAL MEDICINEULTRASOUND IMAGING

FETAL MEDICINEULTRASOUND IMAGING

ANOMALY SCREENING REMAINS ACONTROVERSIAL ISSUE

BUT

A DIAGNOSTIC TEST DEPENDS ON PROPER MANAGEMENT AFTER DIAGNOSIS TO BECOME

EFFICIENT

REFERENCESREFERENCES

1. Eik-Nes SH, Okland O, Aure JC, Ulstein M.Ultrasound screening in pregnancy: a randomised controlled trial.Lancet 1984; 1: 1347.

2. Saari-Kemppainen A, Karjalainen O, Yloslato P, Heinonen OP.Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy.Lancet 1990; 336: 387-91.

3. Ewigman BG, Crane JP, Frigoletto FD, LeFevre ML, Bain RP, McNellis D, and the RADIUS study group.Effect of prenatal ultrasound screening on perinatal outcome.NEJM 1993; 329: 821-7.

4. Neilson JP. Ultrasound for fetal assessment in early pregnancy (Cochrane Review).In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software.